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. 2024 Feb 26:15:1356310.
doi: 10.3389/fneur.2024.1356310. eCollection 2024.

Focused ultrasound therapy in movement disorders: management roadmap toward optimal pathway organization

Sara Rinaldo  1 , Roberto Cilia  2 , Valentina Leta  2   3 , Mariarosaria Gammone  1 , Nico Golfrè Andreasi  2 , Fabiana Colucci  2 , Arianna Braccia  2 , Roberta Telese  2 , Marco Fusar Poli  4 , Vincenzo Levi  5 , Luigi Michele Antonio Romito  2 , Francesco Ghilemetti  6 , Elena De Martin  6 , Maria Luisa Fumagalli  6 , Francesca Epifani  7 , Sara Prioni  4 , Paolo Amami  4 , Sylvie Piacentini  4 , Antonio Emanuele Elia  2 , Grazia Devigili  2 , Vittoria Nazzi  5 , Elisa Francesca Maria Ciceri  8 , Mario Stanziano  7 , Marina Grisoli  7 , Valentina Caldiera  8 , Marisa Catotti  1 , Francesco DiMeco  9   10   11 , Giacomina Clara Moreschi  1 , Roberto Eleopra  2
Affiliations

Focused ultrasound therapy in movement disorders: management roadmap toward optimal pathway organization

Sara Rinaldo et al. Front Neurol. .

Abstract

MRI-guided focused ultrasound (MRgFUS) lesioning is an innovative, safe and effective treatment which provides an innovative development in the field of minimally invasive stereotactic neurosurgery. Based on the application of focused ultrasound energy under full MR planning and thermal imaging control, unilateral lesioning of the thalamus, subthalamic nucleus, and globus pallidus is indicated for the treatment of movement disorders, including essential tremor, Parkinson's disease, and dystonia. We started to apply this technique in February 2019 for the treatment of patients with movement disorders. The authors developed a diagnostic therapeutic care pathway, which is herewith proposed and applied as an explication of standard clinical practice in use. The project was the result of the application of different methods such as Health Technology Assessment (HTA), Strengths, Weaknesses, Opportunities and Threats analysis (SWOT) and Demin -Plan, Do, Check, Act (PDCA) cycle. The aim of this project was to standardize the MRgFUS diagnostic-therapeutic pathway (DTP), describe its application and the appropriateness of different phases (patient selection, intervention phase and follow-up). Here, we described in detail our experience in the DTP application from 2019 up to now in 610 patients with movement disorders.

Keywords: MRgFUS; Parkinson’s disease; clinical pathways; essential tremor; focused ultrasound; thalamotomy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
Diagnostic care pathway for the treatment of unilateral tremor with MR-guided high-field focused ultrasound.
Figure 2
Figure 2
Diagnostic care pathway for the treatment of unilateral tremor with MR-guided high-field focused ultrasound: number of accesses, completed screenings and referring diagnoses.
Figure 3
Figure 3
Grounds for screening failure: data on 78 assessed and excluded subjects. DBS, deep brain stimulation; SDR, skull density ratio (lower than 0.40).
See this image and copyright information in PMC

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